Gliederung

Objective: The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing with aging of the population. However, there is controversy about how aggressive these patients should be treated.

Methods: Patients aged ≥60 years at the onset of SAH were selected from our database and compared in cohorts of age 60-69, 70-79, and ≥80, regarding pre-morbid status, treatment, course of the disease including complications, and outcome. A multivariate analysis was conducted to identify prognostic factors for death and disability.

Results: 256 patients (138 aged 60-69, 93 aged 70-79, 25 aged ≥80) with proven/ suspected aneurysmal SAH were admitted to our hospital from 1/1/1996 to 6/30/2007. The median follow-up was 36.5 months. The WFNS grade worsened with increasing age (p<0.05) and the older the patients the more Coiling (35, 34, and 52 %, respectively) or conservative treatment (11, 16, and 32%, respectively) was carried out (p=0.006). The 1 year-survival rate was 78, 65, and 38% in patients aged 60-69, 70-79, and ≥80, respectively (p=0.0002). Most of the patients (34, 27, and 54 %) died from the initial hemorrhage due to uncontrollable ICP, mortality caused by rebleeding was 5, 8, and 0%. 48, 69, and 75% of patients exhibited a GOS I-III at last follow-up (p=0.006). 70% of patients aged 60-69 with an initial WFNS I-III made a good recovery, whereas less than 10% of patients in the two older age groups with an initial WFNS IV/V made a good recovery. WFNS score and age were extracted as prognostic factors for both death and bad outcome at last follow-up from the multivariate analysis.

Conclusions: In this group of elderly patients, the prognosis of SAH decreases with age and initial WFNS score. The predominant importance of the initial hemorrhage for the mortality in this age group and the poor prognosis warrants a conservative approach in patients aged ≥70 with an initial WFNS score of IV/V. However, treatment of the aneurysm should be strongly considered in patients with a good initial WFNS score.